A Prospective Observational Study to Assess the Impact of Focused Transthoracic Echocardiography on Diagnosis and Management in Patients Admitted to the Intensive Care Unit Post-Cesarean Section.

BACKGROUND: Hemodynamic instability and respiratory distress are leading causes of intensive care unit (ICU) admissions following cesarean section (CS). Focused transthoracic echocardiography (FTTE) may help diagnose or rule out a cardiac cause of the clinical dilemma. We studied the diagnostic and therapeutic impact of FTTE in post-CS patients in the ICU.

PATIENTS AND METHODS: In this prospective observational study, 60 post-CS patients in the ICU requiring FTTE were studied for indications for FTTE. Following FTTE, the hemodynamic cause of hypotension was differentiated as hypovolemia, cardiac failure due to underlying cardiac conditions such as cardiomyopathy or valvular heart disease, sepsis, pulmonary embolism, and myocardial infarction. In respiratory distress, FTTE differentiated pulmonary edema secondary to cardiac causes from non-cardiac causes. FTTE was considered to have a diagnostic impact whenever, in a clinically unsuspected case, it diagnosed a new cardiac disorder, thus helping to narrow down to a single cause out of multiple differential diagnoses or ruled out a cardiac cause in a clinically suspected case. FTTE was considered to have a therapeutic impact whenever it led to an alteration in management.

RESULTS: FTTE diagnosed a new cardiac pathology in 18 (30%) patients and ruled out a worsening of existing cardiac function in 18 (30%) patients with known cardiac disease. An underlying cardiac condition was ruled out in 22 (36.66%) patients, supporting an alternate diagnosis. FTTE led to a change in the management of 45 (75%) patients.

CONCLUSION: FTTE had a high diagnostic impact of 96.66% and a management impact of 75% in post-CS ICU admissions.